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What Causes Radiating Pressure In Neck And Throat Area?

Posted on Fri, 4 Sep 2015

Question: I am a 58 year old male. I have pressure or what I might describe as intensity in my neck and throat area radiating up into mostly my left with a feeling of pressure in my ear with dizziness and loud ringing. The pressure also goes across the bridge of my nose and face. This began on 12-28-14 when I woke up with a significant rash on my upper thighs, hips buttocks, forearms and upper arms. I went to the urgent care and was told I had come in contact with something that I had an allergic reaction to although I don't know what. I was put on steroids which relieved the rash but not the dizziness. Not long after the neck and throat pressure started. I saw my primary care doc in 2-15. he said it could be a histamine reaction from the rash and put me on prescription Flonase with Allegra D which had no effect. In 3-15 in put me on another round of Steroids which did help but did not get rid of the problem. By mid 6-15 the conditions had returned and progressed. I was referred to an ENT who saw no problems with my sinuses, throat or ears and thought it might be Mineres or migraine headaches and advise Excedrine Migraine. This helped with the dull headaches I would also get but nothing more. He advise a hearing test which was mostly normal with some high range hearing loss which I already had. By late 7-15 I began to also have numbness in my left hand and lower left leg. I went to the ER on 8-6 and had an MRI on my head when show no tumors, bleeds or any contrast that would explain the neurological aspects. He suggested another round of steroid. Which I am currently completing but it does not seem to be having a beneficial effect. This problem exist all of my waking hours and can be very intense at time and is disrupting my work and personal life. Otherwise I am healthy. I'm at a loss. There are even time when I lay down and close my eyes and it feels as though someone is touching my face but they are not. During this time I have had no sore throats, sinus congestion or trouble breathing. Again it seems to be nerve related. The next suggestion was to see a neurologist. Can anyone give me an answer as to what may be the cause of this?

Answered by Dr. Ilir Sharka (6 hours later)

Brief Answer:
Your symptoms seem to be related to an atypical trigeminal neuralgia

Detailed Answer:
Hello!

Thank you for asking on HCM!

I read your question carefully and understand your concern.

I would like to explain that, your symptomatology is a little complicated and is difficult to differentiate it as a typical type of headache.

Your symptoms seem to be related to an atypical trigeminal neuralgia. It is an inflammatory disorder affecting the trigeminal nerve. It is atypical, because usually the pain in trigeminal neuralgia is throbbing, electric like and not pressure.

I would also mention atypical facial pain (which may be called a type of trigeminal neuralgia), but it is called in this way, because it doesn't fulfill the international criteria of headache for other typical facial headaches.

It is known that an unspecified allergic reaction can lead to a hypersensitivity of the trigeminal nerve causing a trigeminal neuralgia.

The disorders I mentioned before have also a psychological factor on its basis.

So I recommend consulting with a neurologist for a careful physical examination for neurological signs and perform routine blood test, inflammation tests (fibrinogen, PCR, sedimentation), a brain MRI to exclude other possible intracranial causes that may mimic this clinical scenario.

I would advise to discuss with your attending physician on the treatment options and consider starting on an antiepileptic drug (carbamazepine, gabapentine, lamotrigine) or an antidepressant (amytriptiline or SSRI), which have shown good results in chronic facial nerve pain.

Hope to have been of help!

Feel free to ask any other questions whenever you need!

Greetings! Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (33 hours later)

Thanks for that information. Some additional recent information that I can add might also be helpful. I visit my fitness center at work regularly and even though I have not felt well I have forced myself to go. On Tuesday 8-11 I did some leg exercises and notice that I felt some swelling in my right knee. I skipped the fitness center on Wed and went on Thursday where I walked on the tread mill about 2 miles. After walking I notice both knees felt swollen and I was having some difficulty walking as a result. There was never any pain. I took a closer look Thursday night and in fact both of my knees were swollen and my ankles were slightly swollen. Today the swelling in my knees is mostly down but I feel a swollen sensation in my hands though I don't see any swelling. Throughout this entire situation beginning in 01-15 I've not experienced any pain except for a dull headache coming from the pressure in my neck and ears. There has been no tingling either. It's a bit hard to say at this point whether the numbness I described earlier is in fact numbness or swelling in different area including my neck area and ears. I've never actually lost feeling. It's just a sensation. It's as if my body is reacting to something. I hope this helps.
Based upon what I have read about atypical trigeminal neuralgia, this does not seem to coincide with my symptoms. Again I have no throbbing pain or electrical type of feeling. This is really a feeling pressure or swelling in my neck and ears that is always there and is at times very intense and annoying but not painful along with the other more recent symptoms I have described above. Still looking for help.

Answered by Dr. Ilir Sharka (15 hours later)

Brief Answer:
I recommend performing further tests to establish the diagnosis

Detailed Answer:
Hello again!

Thank you for the detailed information provided!

As I mentioned before your symptoms do not fulfill the criteria for a certain type of headache ( based on ICHD-2 criterias) for a primary headache.

That’s why I mentioned the term “atypical facial pain”, which has been classified as an atypical variant of trigeminal neuralgia, which does not have the typical characteristics of this disorder ( like episodic throbbing electrical pain).

The pressure and the continuous pattern is characteristic of another type of headache, which is the tensive type headache, which is mainly caused by psychological and physical stress, leading to involuntary contractions of the muscles surrounding the scalp.

Both these disorders lay on a psychological triggering factor.

From the other side, these are primary headache disorders, which mean that other causes of secondary headaches should be excluded by several tests before concluding these diagnoses.

I insist in performing the tests, before mentioned: a routine blood test, inflammation tests, kidney and liver function tests, blood electrolytes, and for sure a brain MRI to examine carefully all the structures (brain, bones, vessels, surrounding tissues).

Regarding your swelling in your joints, they are not a sign of any neurological disorder, but may indicate a rheumatologic disorder.

If suspicions are raised by the inflammation tests results, I recommend consulting with the rheumatologist and perform further tests for this issue.

To conclude, if all the above tests result normal, I would advise to discuss with your neurologist the possibility of starting an antidepressant or gabapentine, which have shown to be successful in chronic atypical facial pain.

Hope to have been of help!

Best wishes,
Dr. Iliri

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar